Adoption of telehealth services across state lines is being hindered by the time-consuming process of obtaining state medical licenses,according to a CO3 study released this month, FierceHealthITreports (Dvorak, FierceHealthIT, 2/26).

For the study, researchers sent a 30-question survey to health professionals across the U.S. who process medical licensure applications (Rogove, C3O Telemedicine study, 2/11).

Findings

More than half of respondents said they process more than 100 applications annually (C3O Telemedicine release, 2/25). Of those:

54% said the application process takes longer than 12 hours; and

17% said the process takes four hours to nine hours (FierceHealthIT, 2/26).

After the application process is complete, the amount of time it took to acquire licenses varied among states. For example, it took one to three months to obtain licenses in Indiana, Arizona and Virginia, while it took at least 10 months in California, Illinois and Texas (C3O Telemedicine release, 2/25).

Just 8.3% if respondents said all states were “reasonable in processing the applications,” according to the study.

Comments

The authors concluded that state medical license portability “continues … to remain elusive for a solution that will allow for the exponential and timely growth of telemedicine.”

They added, “If there were ever a time for the mission of state medical licensure boards to rally in support of shaping the future of health care delivery by finding a solution for removing a most significant barrier to telemedicine, the time is now” (FierceHealthIT, 2/26).

“It’s only February, but telehealth is clearly a priority to state lawmakers. One hundred telemedicine-related bills have been introduced to define telehealth and telemedicine, redefine licensed provider practice standards, remove artificial barriers or improve coverage and payment options. Some bills seek to improve the telemedicine policy landscape while others risk to severely limit health providers’ clinical decision making and patient choice. ATA members are monitoring state activity using the ATA legislative and regulatory trackers, and seizing the opportunity to educate lawmakers about the clinical application of telemedicine and the unintended consequences of over regulation. Join the ATA State Policy webinar this Thursday, Feb. 26, at 1 p.m. EST, to hear about legislative proposals and possibilities for engagement.”

According to Christopher Cheney ofHealthMedai Leaders: “Since the model Compact legislation was finalized by state medical board representatives and released to the states for their consideration at the end of 2014, it has been introduced in 12 state legislatures and endorsed by 26 state medical and osteopathic boards. We expect both counts to continue to grow,” Humayun Chaudhry, DO, president and CEO of theFederation of State Medical Boards, said last week.

So far, the draft has been introduced at statehouses in Iowa, Maryland, Minnesota, Montana, Nebraska, Oklahoma, South Dakota, Texas, Utah, Vermont, West Virginia and Wyoming. The FSMB is tracking the legislation’s progress on the organization’s website.

The Compact also has the support of the American Medical Association, the Council of Medical Specialty Societies, the Society of Hospital Medicine, and many other national and state provider, hospital, and specialty organizations. Consumer and patient advocacy organizations like the South Dakota AARP chapter have also been very supportive of the Compact and its potential for improving access to care.”

Critics of the CompactThe FSMB has lashed out at critics of the Compact, among them Independent Physicians for Patient Independence (IP4PI) and theAssociation of American Physicians and Surgeons (AAPS). In a letter to the US Senate dated Jan. 26, AAPS called the Compact “little more than a pretext for transferring state sovereignty to out-of-state, private, wealthy organizations” and called for “an investigation of the FSMB to “[evaluate] the very reason for their existence on top of state licensure boards and specialty boards.”

Critical Mass of States Needed to Launch Compact
Several states will have to enact laws codifying the model legislation before the Compact can seat commissioners and launch.

“The model Compact sets a minimum of at least seven states to enact the legislation in order to enable functionality and the creation of an interstate commission. The commission would be charged with the administrative functions of the Compact and be led exclusively by members of participating state medical boards,” Chaudhry says.

Just fast tracked on Telemedicine and eHealth’s website is an important survey of professional license companies that deal with over 1,000 applicants a year to practice telemedicine in multiple states. Dr. Herb Rogove and co-authors sent surveys to participants who have experience with telemedicine as well as on site practices in multiple states throughout the continental United States and its territories. Here are the key elements of this article:

Fifty four percent of the respondents felt it was a prolonged process because of variable requirements and deficiencies within the medical board office.

Difficulties were centered around failure to respond to questions, lack of cooperation, inability to use FCVS, lack of a uniform process and consistency across all medical boards.

Lost documentation occurred and 79% had to resubmit documents.

The most reasonable states (reasonable defined as responsive, cooperative, willingness to expedite, and knowledge) were identified as Oregon, Wyoming, Pennsylvania, and Montana.

The respondents felt the most difficult states to deal with were: California, Texas, Arkansas, and Massachusetts.

The shortest time to obtain a medical licenses was felt by respondents to be Indiana, Arizona, and Virginia.

The longest time to obtain a medical license was thought to be California, Illinois, and Texas.

Variability of requirements, which is set by each state, was considered to be a major issue.

Reciprocity for all states was a major suggestion by those who were surveyed.

This survey illustrated that medical license portability continues to be a major and time consuming barrier for expanding telemedicine’s rapid deployment to areas in need of physicians. Despite the recent compact by the Federation of State Medical Boards, the process may be streamlined but lacks the major impact of full reciprocity of all states.

John Brumbach reports: This year the Washington State Legislature is considering legislation that would ensure Telemedicine services are reimbursable for those enrolled in commercial, managed care and public employee benefit plans. Telemedicine, which consists of health care services provided via interactive video and video technology, has built strong bipartisan support in Olympia because of the potential to increase access to more diverse services in rural and other under served areas. These services include telepsychiatry, telepain management, teleradiology and many other specialties not commonly available in all areas. In addition, a study showed that covering telemedicine could save Medicaid $37 million in reduced primary and follow-up care costs. Despite this support, previous efforts have failed to make it through the legislature to the Governor’s desk.

The last effort to pass legislation began in 2013 and received strong support in the House, but died twice in the Senate during the 2013 and 2014 sessions, where there was no corresponding companion bill.

Reasons for telemedicine’s failure in the Senate appeared to center around concerns from health plans around a lack of flexibility for reimbursement levels, as well as social conservatives regarding the potential to ease access to chemical abortions.

Health plans have fully embraced this version of the bill, while it remains to be seen whether or not social conservative concerns will be addressed, or if those concerns will be enough to halt the progress of the bill.

HB 1403 is scheduled to be voted out of the House Health Care & Wellness committee on February 3rd.

TALLAHASSEE (CBSMiami/NSF) – Pointing to a need to increase access to health care in areas such as rural communities, a bipartisan group of House and Senate leaders Tuesday expressed confidence they will reach agreement this year on a plan to boost the use of telemedicine in Florida.

While some providers such as hospitals have started moving forward with telemedicine lawmakers need to put guidelines in state law.

For instance, Bean said such a law would allow Florida’s Medicaid system to pay for care through telemedicine, something it cannot do now.

Lawmakers during the past few years have filed telemedicine bills, but the House and Senate have not been able to reach agreement.

But during the news conference Tuesday, leaders said they expect to work out differences on regulatory issues that have led to past disagreements. One of the key regulatory issues in the past has been about whether out-of-state physicians should be allowed to provide telemedicine to patients in Florida.

An agreement has been reached to require such health-care providers to be licensed in Florida if they provide telemedicine in the state and also to prevent them from practicing outside their areas of specialty — an issue known in the industry as scope of practice. Florida physicians would be able to use telemedicine to consult with out-of-state doctors.

Dive Brief:

The House Energy and Commerce Committee released a “discussion document” seeking feedback on its 21st Century Cures initiative, which is filled with a number of healthcare IT proposals.

Key provisions include one that would create a process at the US Food and Drug Administration to expedite the review of “breakthrough” medical devices; another that would require that data be shared by those receiving grants from the National Institutes of Health; and a third to advance telemedicine opportunities for Medicare beneficiaries.

However, while suggestions within the provision for improving Medicare’s telehealth policy are broadly considered to be a step in the right direction, a letter from the American Hospital Association to committee chairman Rep. Fred Upton (R-MI) says they don’t go far enough.

Dive Insight:

The ”Advancing Telehealth Opportunities in Medicare” proposal calls on HHS to draw up a methodology to expand coverage and payment for telehealth services nationally. There are limitations to the provision, however. It will only apply if the Centers for Medicare and Medicaid Services find that those telehealth services ”would reduce [or would not result in any increase in] net program spending under this title.”

According to the AHA, the proposal does not address technology limitations within Medicare itself, or how remote monitoring would be funded.

“We also are concerned that the requirement for the Medicare actuary to certify telehealth cost neutrality for specific services would be hard for HHS to operationalize, and would add a time consuming step when technology is advancing at a rapid pace,” the AHA wrote.

In Arkansas, Rules Restrict e-Services By Physicians

Teladoc Inc. of Dallas is the latest telemedicine provider to be shut out of Arkansas because of Arkansas State Medical Board rules involving physician-patient relationships.

“The board has traditionally defined the establishment of a doctor-patient relationship as: an in-person history and a physical,” board attorney Kevin O’Dwyer told Arkansas Business recently.

And without that, the telemedicine doctors — unless they’ve seen a patient in person — can’t treat Arkansans, making Arkansas one of the handful of states that don’t allow telemedicine companies in their state.

O’Dwyer said the only reason the board has the requirement is to protect the patient.

Still, O’Dwyer said the board discusses the issue “regularly. … We haven’t seen a model from any of these companies that would satisfy, in the board’s opinion, the regulation.”

Teladoc had been offering the service in Arkansas since 2008, its CEO, Jason Gorevic, said. But recently, the board “made it clear that they would take action against physicians who were practicing telemedicine,” Gorevic said.

Teladoc suspended its service in November, pending approval from the board. It has 70,000 members in Arkansas.

Gorevic said Teladoc has been trying to get a meeting before the board to explain its practice and telemedicine.

“They have, unfortunately, declined our offer to come in and present,” Gorevic said. “In the meantime, there are many other parties in the state who are interested in telemedicine and see its promise for reducing costs, improving quality of care and improving access to care.”

Teladoc offers services across the country except in Arkansas and Idaho, where it also recently suspended its service because of its medical board rules. But Gorevic said he hopes that Teladoc will be allowed to practice in Idaho soon, thanks to pending legislation.

Teladoc sells its services primarily to employers and health plans to use as part of their benefits packages. The members then have full-time access to a national network of board-certified, state-licensed physicians who can be connected to a patient within about eight minutes, Gorevic said.

The patient can decide to interact with the doctor by a video or phone consultation. Or a patient can send a photo of the ailment to the doctor.

Comments: Since 2008 and now the Board is weighing in? Refusing to meet with Teladoc? Patients are free to use to service or NOT? What kind of message is the Arkansas state medical board telling their citizens?

On Monday, lawmakers in the House circulated a draft bill that would grant HHS more freedom to waive Medicare restrictions on reimbursements for telehealth services, Politico‘s “Morning eHealth” reports.

Draft Bill Details

Members of a congressional “telehealth working group” drafted the measure, called Advancing Telehealth Opportunities in Medicare (Gold, “Morning eHealth,” Politico, 1/13). The group includes Reps.:

Bill Johnson (R-Ohio);

Bob Latta (R-Ohio);

Doris Matsui (D-Calif.);

Frank Pallone (D-N.J.);

Fred Upton (R-Mich.);

Gregg Harper (R-Miss.);

Greg Walden (D-Ore.); and

Peter Welch (D-Vt.) (Pittman, Politico Pro, 1/12).

According to “Morning eHealth,” the draft bill contains provisions that would allow Medicare to make additional payments for telehealth services if they meet specific requirements, such as:

Providing unmet medical needs; or

Reducing costs (“Morning eHealth,” Politico, 1/13).

The measure would require CMS’ chief actuary to ensure that the telehealth payments “would reduce (or would not result in any increase in) net program spending” (Young, CQ Roll Call, 1/13).

Draft Bill Circulation

The draft bill was circulated by eight members of the House Energy and Commerce Committee, including Upton, who serves as the committee chair, and Pallone, a ranking member of the committee.

The group of lawmakers is hoping to get feedback on the measure from industry stakeholders by Jan. 26. If the lawmakers receive positive feedback, they could introduce a final bill in February, according to congressional and lobbying sources. If the feedback is negative, it could take longer for a final measure to be released (Politico Pro, 1/12).

Reaction

The Alliance for Connected Care commended the draft, saying in a statement that Medicare beneficiaries “deserve the same access to telehealth that consumers in the commercial marketplace and Medicare Advantage already enjoy.” According to CQ Roll Call, people who have traditional Medicare plans currently do not have the same access to telehealth as those enrolled in Medicare Advantage (CQ Roll Call, 1/13).

Meanwhile, Health IT Now Executive Director Joel White in a statement said that while “the bill is a great step in the right direction in addressing Medicare’s outmoded treatment in how it incentivizes telemedicine,” it “does not go far enough to incent telemedicine in Medicare.” Specifically, White said Health IT Now is “disappointed that the draft bill continues to rely on state compacts in addressing burdensome state medical licensure system,” which White said could delay progress (Health IT Now release, 1/13).